1588774830 NPI number — PETER W PINTO CRNA

Table of content: PETER W PINTO CRNA (NPI 1588774830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588774830 NPI number — PETER W PINTO CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINTO
Provider First Name:
PETER
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PINTO
Provider Other First Name:
PETER
Provider Other Middle Name:
W
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1588774830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1684
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASCAGOULA
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39568-1684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-762-9080
Provider Business Mailing Address Fax Number:
228-762-0065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3882 BIENVILLE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEAN SPRINGS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39564-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-872-6629
Provider Business Practice Location Address Fax Number:
228-762-0065
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  R854706 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 430064343 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 587210340C . This is a "AHS STATE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 0122707 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 587210340C . This is a "BLUE CROSS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 009994065 . This is a "ALACAID" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com